___________________________________________________________ School Name ____________________________________ _____________________ Primary Contact Name Phone Number ___________________________________________________________ Address (tests and scores will be sent here) _______________________________ _________ _______________ City State Zip ___________________________________________________________ Requested Testing Week

___ Check or Money Order Enclosed or bill to: ___ VISA ___ MC ___ DISC

Credit Card #: ___________________________________________________ Expiration Date: ______________ CVC: ____________

Name on Card: ________________________________________________________

PRIVATE SCHOOL ORDER FORM

Family Learning Organization provides standardized achievement testing for homeschooling families, groups, private schools, and school extension programs. Schools and other programs have two weeks to test starting on the desired testing week. Scoring takes one to two weeks and the results are mailed to the address provided on this form.

Testing Agreement for School Test Administrator/School Contact:

I understand these are non-consumable materials. I will ensure the tests are kept in a secure location and only accessible to the students during testing. No part of these test booklets will be copied or reproduced in any manner. I agree to return the materials within two weeks of the desired testing date. I understand that the school is responsible for the return postage and that for unused tests that are returned for any reason, FLO will refund the cost of the test minus a 15% restocking fee.

____________________________________________ __________________ Signature of School Contact Date

CAT/6 TerraNova 2nd Edition, Grades K-12 CTBS TerraNova 1st Edition, Grades 1-12 CAT/5 California Achievement Test, Grades K-12 CS California Achievement Test Survey, Grades 2-12

*Orders with 10 or more students will receive a 10% discount. Use discounted rates below to calculate total.

ORDER TOTALS SUMMARY # of CAT/6 (Grade K) tests ordered _______ x $35 or $31.50* = ________ # of CAT/6 (Grades 1-12) tests ordered _______ x $40 or $36* = ________ # of CTBS (Grades 1-12) tests ordered _______ x $30 or $27* = ________ # of CAT/5 (Grades K-12) tests ordered _______ x $37 or $33.30* = ________ # of CS (Grades 2-12) tests ordered _______ x $37 or $33.30* = ________

TOTAL = ___________

v

Standardized Test Order Form for Private Schools

Student First Name

Student Last Name

Birthdate

Student Last Name

Birthdate

Grade

Grade

Student First Name

Test Code (CAT/6, CTBS, CAT/5, CS): ___________

1

Standardized Test Order Form for Private Schools

Student First Name

Student Last Name

Birthdate

Student Last Name

Birthdate

Grade

Grade

Student First Name

2

Test Code (CAT/6, CTBS, CAT/5, CS): ___________

Student First Name

Student Last Name

Birthdate

Student Last Name

Birthdate

Grade

Grade

Student First Name

Standardized Test Order Form for Private Schools 3

Test Code (CAT/6, CTBS, CAT/5, CS): ___________